Archive for 2009



first aid

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Hemorrhoids


Hemorrhoids are swollen varicose or piles in the anal area. It is painful when the body part is slipping or falling down from its usual position ( prolapsed ) and thrombosed. It bleeds when passing stools in the rectum that maybe a symptoms of serious disease like cancer of the rectum and colon.



What are the symptoms of Hemorrhoids?


  • Bleeding of rectum colored bright red blood after passing hard stools.

  • Prolapsed Hemorrhoids – Soft lump or cluster of lumps around the anus. Lumps are abnormal mass or swelling parts with indefinite size and shape.

  • Slimy mucus discharge from the anus

  • Anal itch.



Common Causes:


  • Increased pressure on the anal and rectal veins due to persistent constipation and straining when passing stool.

  • Pregnancy

  • Portal hypertension



Prevention Tips:


  • Drink plenty of fluids

  • Take high Fiber for diet. Eat foods w/high fiber like cereals, vegetables, fruits.

  • Do regular exrcises

  • Establish a regular bowel habit.

  • Do not sit or bear down when sitting on the toilet.

  • Take warm sitz baths. Soaking in hip level warmwater for 10 – 20 mins

  • Consult a doctor if you have anal bleeding



Cardiac Arrest

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A cardiac arrest, also known as cardiopulmonary arrest or circulatory arrest, is the abrupt cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole.

Causes

Causes of cardiac arrest include:
  • Ventricular fibrillation —a rapid, irregular heart rhythm preventing any circulation of blood (most common cause of sudden cardiac arrest)
  • Ventricular tachycardia—a rapid, but regular heart rhythm that, if sustained, may turn into ventricular fibrillation
  • Dramatic slowing of heart rate due to failure of its pacemaker or severe heart block (interference with electrical conduction)
  • Respiratory arrest
  • Choking or drowning
  • Sudden loss of blood pressure
  • Unknown causes

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition.
Risk factors include:
  • Enlarged heart
  • Congenital heart disease
  • Improperly functioning heart valves
  • Conditions affecting the heart's electrical system
  • Severe metabolic imbalances
  • Adverse drug effects, such as from:
    • Drugs to treat abnormal heart rhythms
  • Lung conditions
  • Trauma to the chest
  • Extensive blood loss
  • Excessive overexertion in people with heart disorders
  • Use of illicit substances (eg, cocaine)

Symptoms

Symptoms include:
  • Loss of consciousness
  • No breathing
  • No pulse
Prior to cardiac arrest, some patients report the following symptoms or warning signs in the weeks before the event:
  • Chest pain
  • Weakness
  • Pounding in the chest
  • Feeling faint

Diagnosis

The first person to respond to a cardiac arrest should check if the person is responsive. Shake the shoulders and ask, "Are you OK?" If there is no response, call 9-1-1. If there are other people around and you can perform CPR (cardiopulmonary resuscitation), send someone to call 9-1-1 and turn your attention to the victim. Check if the person is breathing. Tilt the head back to open the airway. Put your cheek near the person's mouth and nose; look, listen, and feel for air movement. If no movement is detected, CPR should be started.

Treatment

Prompt treatment improves the chance of survival. The four steps in the cardiac chain of survival are:

Call For Help

Immediately call for emergency medical support. Call for emergency assistance as soon as you notice cardiac warning signs or suspect a cardiac arrest has occurred.

Start CPR

CPR helps keep blood and oxygen flowing to the heart and brain until other treatment can be given. The heart and brain are very susceptible to low oxygen levels. Permanent damage can occur, even with successful resuscitation. During CPR, the rescuer positions the head to open the airway, breathes air into the patient, and compresses the patient's chest.

Defibrillation

Once on the scene, emergency medical technicians or paramedics will assess the heart rhythm and determine whether the rhythm warrants defibrillation (eg, ventricular fibrillation or tachycardia). Defibrillation sends an electrical shock through the chest. The surge of electricity aims to stop the ineffective, irregular heart rhythm. This may allow the heart to resume a more normal electrical pattern. Automated external defibrillator's check the heart rhythm before instructing the rescuer to give the shock.

Advanced Medical Care

Paramedics at the scene and doctors at the hospital provide essential medical care and intensive monitoring. They will give drugs, insert a tube to maintain an open airway, and manage emergency care. Epinephrine is often given early to make the heart more receptive to electrical impulses and improve blood flow to the heart and brain. The patient will receive oxygen. Even if an effective heart rhythm is restored, low oxygen levels may cause serious complications, including damage to the heart, brain, and other vital organs. Doctors will attempt to find and correct the underlying cause of the cardiac arrest.
At the hospital, the doctor will ask about:
  • Symptoms prior to the collapse
  • The patient's medical and drug history
If the patient survives, the doctor will:
  • Assess the electrocardiograms performed by the emergency medical personnel
  • Perform a physical exam
  • Confirm a cardiac arrest has occurred
  • Look for the cause
  • Evaluate the effects of pre-hospital care
  • Order additional blood and diagnostic tests to help determine the cause of the arrest
A telemetry machine will continually monitor the heart's electrical activity.

Prevention

Become aware of heart disease warning signs and promptly seek treatment for any that develop. If you do not have a heart condition, follow the rules of primary prevention of heart disease. If you have a heart condition or may be at high risk for one, ask your doctor about how to reduce your risk of sudden cardiac arrest. You might be a right candidate for certain medications that prevent heart arrhythmias or implantation of ICD device.
Also, if you are known to be at high risk, you may consider purchasing an automatic external defibrillator (AED) for home use. Discuss it with your doctor.
RESOURCES:
American College of Cardiology
http://www.acc.org
American Heart Association
http://www.americanheart.org
Sudden Cardiac Arrest Association
http://www.suddencardiacarrest.org/
CANADIAN RESOURCES:
Canadian Cardiovascular Society
http://www.ccs.ca/home/index_e.aspx
Canadian Family Physician
http://www.cfpc.ca/cfp/
REFERENCES:
Braunwald E, Zipes DP, Libby P, et al. Heart Disease: A Textbook of Cardiovascular Medicine . 6th ed. Philadelphia, PA: WB Saunders Company; 2001.
Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 3: adult basic life support. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation. Circulation . 2000; 102:I22
Heart Rhythm Society website. Available at: http://www.hrsonline.org/ . Accessed October 6, 2005.
Rakel RE, Bope ET. Conn's Current Therapy 2001 . 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
Rea TD, Eisenberg MS, Becker LJ, et al. Temporal trends in sudden cardiac arrest. Circulation . 2003; 107:2780.
Rosen P. Emergency Medicine: Concepts and Clinical Practice . 4th ed. St. Louis, MO: Mosby-Year Book Inc.; 1998.
Stevenson LW, Desai AS. Selecting patients for discussion of the ICD as primary prevention for sudden death in heart failure. J Card Fail . Aug 2006;12:407-412. Review.

Last reviewed November 2008 by Michael J. Fucci, DO
Last Updated: 11/17/08
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MUSCULOSKELETAL INJURIES

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Fractures - any break in the continuity of a bone. It can be open or closed fracture.

Closed injury - one in which the overlying skin is intact. Proper splinting helps prevent closed injury fracture from becoming an open fracture.

Open injury - one in which the skinhas been broken or torn either from the
inside by the injured bone or from the outside by the object that caused the penetrating wound with the associated bone injury.

Dislocation - injury in which a bone is move out of its normal position in a joint and remains that way.

Sprain - injury in which ligaments (bone to bone) are stretched or partially torn, commonly associated with joint injuries.

Strain-injury in which a muscle or a muscle and tendon (bone to bone) are over extended.


Signs and Symptoms of a Muscle Injury
1. Deformities or angulation: compare with opposite limb
2. Pain and tenderness upon palpation or movement
3. Crepitus (grating)- a sound or feeling of broken bone ends rubbing together
4. Swelling
5. Bruising or discoloration
6. Exposed bone ends
7. Joint locked in position- reduced motor ability or reduced ability to articulate joint.
8. Numbness and paralysis- may occur distal to side of injury caused by bone pressing on anerve.
9. Circulatory compromise distal to injury evidenced by alteration in skin color, temperature, pulse or capillary refill.
Splinting - applying a device to stabilize any painful, swollen,or deformed body part.

Reasons for splinting includes:

1. To prevent motion of bone fragments or dislocated joints
2. To reduce pain and suffering
3. To minimize damage to the soft tissue
4. To prevent closed fracture from becoming an open fracture
5. To minimize blood loss or shock


Six basic type of Splinting






Six basic types of splints

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1. rigid splint
3. traction splint
4. sling & swathe
5. improvise splint
6. anatomical splint

 General rules for splinting:

1. Always communicate your plans with your patient, if possible ask permission.

2. Before immobilizing an injured extremity expose and control bleeding.

3. Always cut away clothing around the injury site before immobilizingthe joint.Remove all jewellery from the site and below it.

4. Assess pulse, motor function and sensation (PMS).

5. If limb is severely deformed or distal circulation is compromised (cyanosis) Distal to fracture site or no distal pulse, align the bone with gentle tractioning (pulling). If pain or creptus worsen, discontinue. Always follow local protocol.

6. Do not attempt to push protruding bone end back intoplace. However, when realigning may slip back into place. Make a note if this occurs.

7. For patient's comfort and proper immobilization, pad voids between the body and the splint, since many rigid splints do not conform to body curves.

8. Pad the splint before applying it.

9. If a joint is injured, immobilize it and the bones above and below.

10. Splint as you found it.


 
 



Soft Tissue Injuries

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Other Injuries: Musculoskeletal Injuries


Soft Tissue Injuries - commonly referred to as wounds, are injuries to the skin, muscles, nerves, and bloods vessel.

Close wounds - injury to the soft tissue beneath unbroken skin.

Pre - hospital treatment for Closed Wounds:
Used universal precaution, active EMS and secure the scene.





1. Apply "RICE" method: Rest, Ice, Compress and Elevate.
2. Monitor the patient for any rapid change in vital signs that might indicate
internal bleeding, which should be treated by a physician.
3. Treat for shock
4. Transport the patient as soon as possible.

To recognize Closed Wounds are the following:

1. swelling
2. tenderness
3. discoloration
4. possible deformity

Open wounds - a soft tissue injury resulting in breaking of the skin.

Pre - hospital treatment for Open Wounds:

Used universal precautions, active EMS and secure the secene.
1. Expose the wound. Remove all clothing and expose soft tissue. Avoid removing clothing by pulling it over the
patient's head. Best method is to remove clothing by cutting with trauma scissors.
2. Control bleeding. Begin with direct pressure or indirect pressure and elevation. If wound continues to bleed use a
pressure point. Use a tourniquet only as a last result.
3. Prevent contsamination. Remove debris and contamination around the surface of the wound. Do not try to remove
embedded particles.
4. Dress and bandage.
5. Cover the paient.
6. Treat for shock.
7.Transport the patient as soon as possible.



Types of Open Wounds:

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1. scratches/ abrasions
2. laceration - regular and irregular




 
3. penetration and puncture wounds
4. avulsion
5. amputations


6. crushing injury (may be open or closed)


 
7. gunshot wounds

 
8. impaled objects










































































































































































Dressing - any material used to cover a wound that helps control bleeding and aid in the prevention of additional contamination.
Bandage - any material used to hold a dressing in place.
Occlusive
dressing - any water - resistant material (plastic or waxed paper) applied to a wound to prevent the entrance of air and the loss of moisture from internal organs.
Bulky
dressing - multiple stacked dressing made to form a single dressing 2-3 cm thick, such as a sanitary towel or any simila material.

When applying a bandage and dressing you should be able to:

1. Control bleeding.
2. Apply the dressing using aseptic technique.
3. Cover the wounds completely.
4. Ensure that the dressing and the bandage are firm, fixed and comfortable, but not so tight as to effect circulation
5. Ensure there are no losse ends that can get caught.
6. Avoid covering the fingertips.